EX. Exit Interview

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EX. Exit Interview module of JSTAR 2013

Label Type Description
11EX-0 Question [To the interviewer: Read out the following statement.]
11EX-1 Question [To the interviewer: Show Card 11EX-1 in asking the following question.] What is your relationship to Mr./Mrs./Miss __________ (subject person)?
11EX-2 Question May I ask you some questions about Mr./Mrs./Miss __________ (subject person)?
11EX-3 Question [To the interviewer: Read out the following statement and terminate the interview.] [Interviewer read-out: The interview is over. Thank you for your cooperation.]
11EX-4 Question Thank you. In which month and year did Mr./Mrs./Miss __________ (subject person) pass away?
11EX-6 Question [To the interviewer: Show Card 11EX-6 in asking the following question.] Which of the following best describes the cause of his/her death?
11EX-7 Question Could you tell me the specific cause?
11EX-8 Question [To the interviewer: Show Card 11EX-8 in asking the following question.] What was his/her disease?
11EX-8-1 Question At the time of our last visit, we were told that Mr./Mrs./Miss____ was still working. When did he/she stop working?
11EX-8-2 Question Why did he/she stop working?
11EX-9 Question [To the interviewer: Show Card 11EX-9, in asking the following question.] Where did he/she pass away?
11EX-10 Question Had he/she been hospitalized or institutionalized in a care facility until immediately before he/she died at home?
11EX-11 Question How long did he/she stay in the hospital?
11EX-11-2 Question Where is the hospital located? Please choose the answer that best describes the location as seen from the place in which Mr./Mrs./Miss __________ (subject person) was living in _____ / ___ (month/year) at the time of our last visit.
11EX-11-3 Question Who chose the facility?
11EX-11-4 Question How much did the hospitalization cost in total?
11EX-11-4-2 Question Who paid the hospitalization expenses? Please select all that apply.
11EX-11-5 Question Was he/she at home or in a care facility before he/she died in the hospital?
11EX-12 Question How long did Mr./Mrs./Miss __________ (subject person) stay in the facility?
11EX-12-1 Question Where is the facility located? Please choose the answer that best describes the location as seen from the place in which Mr./Mrs./Miss __________(subject person) was living in _____ / ___ (month / year) at the time of our last visit.
11EX-12-2 Question Who chose the facility?
11EX-12-3 Question How much did it cost per month of stay?
11EX-12-4 Question Was it necessary to make any down payment at the time of admission into the facility? If yes, how much was it?
11EX-12-4-2 Question Who paid the cost of the care facility? Please select all that apply.
11EX-13 Question Did he/she need to be assisted and/or cared for at home before he/she died?
11EX-13-1 Question Who were the main caregiver(s)? If more than one, select up to three people.
11EX-13-2 Question Had he/she been certified as requiring assistance or care under the Long-term Care Insurance Program before he/she died?
11EX-13-3 Question What was the level of the required care before death?
11EX-13-4 Question Had he/she been receiving any assistance and/or care services at home?
11EX-13-5 Question How much had been paid out of pocket for such at-home assistance and/or care services per month?
11EX-13-5-2 Question Who paid for such at-home assistance and/or care services? Please select all that apply.
11EX-14-0 Question Let me ask about the family status of Mr./Mrs./Miss __________ (subject person). At the time of our last visit in __________ / ____ (month/year), we were ( ). Did his/her marital status change between then and the time of his/her death?
11EX-14-1 Question When was his/her spouse or common-law spouse born?
11EX-14-2 Question What is the highest level of education Mr./Mrs./Miss __________ (subject person)’s spouse received? Did he/she graduate from that school?
11EX-15-0 Question At the time of our last visit in __________ / ____ (month/year), we were ( ). Did the situation change between then and the time of his/her death?
11EX-15-1 Question Let me ask about Mr./Mrs./Miss __________ (subject person)’s son(s)/daughter(s) (hereinafter collectively referred to as “child(ren)” regardless of age). This is what we were told in our last visit in __________ / ____ (month / year).
11EX-15-2 Question Has the survival status of the t/nd/rd/th child changed?
11EX-15-2a Question Let me ask about the spouse of Mr./Mrs./Miss __________ (subject person)’s deceased son/daughter. Which of the following best describes the situation?
11EX-15-3 Question Did the marital status of the t/nd/rd/th child change?
11EX-15-4 Question Was there any change in the place of residence of the t/nd/rd/th child?
11EX-15-5 Question How long does it take from Mr./Mrs./Miss __________ (subject person)’s residence to the t/nd/rd/th child’s new residence?
11EX-15-6 Question Was there any change in the economic status of the t/nd/rd/th child? (If he/she is married and is a full-time homemaker, please answer about the situation of the couple.)
11EX-15-7 Question Was there any change in the work or school status of the t/nd/rd/th child?
11EX-15-8 Question While Mr./Mrs./Miss __________ was still alive, did his/her t/nd/rd/th child have any children and if yes, how many?
11EX-15-9 Question Is the information on the situations of Mr./Mrs./Miss ___________ (subject person)’s son(s)/ daughter(s) all updated now?
11EX-15-10 Question Now, let me ask about the additional son(s)/daughter(s) (hereinafter collectively referred at as “child(ren)” regardless of age).
11EX-15b-1 Question Is the t/nd/rd/th child (among the newly born or adopted) male or female?
11EX-15b-2 Question Is the child Mr./Mrs./Miss __________ (subject person)'s biological child or adopted?
11EX-15b-3 Question How old is he/she? Or when was he/she born?
11EX-15b-4 Question Where does he/she live? Please choose the answer that best describes the location as seen from Mr./Mrs./Miss __________ (subject person)’s place of residence as of the time of our last visit.
11EX-15b-4a Question How long does it take from Mr./Mrs./Miss __________ (subject person)’s residence to that of the child?
11EX-15b-5 Question Is the child financially independent? (If he/she is married and is a full-time homemaker, please answer about the situation of the couple.)
11EX-15b-6 Question Which of the following most accurately describes the current status of the child?
11EX-15b-7 Question What is the highest level of education of the child? Did he/she graduate from that school?
11EX-15b-8 Question Is he/she married?
11EX-15b-9 Question Does he/she have any children and if yes, how many?
11EX-16 Question Who was/were living with Mr./Mrs./Miss __________ (subject person) immediately before his/her death?
11EX-17 Question Sorry for my intrusive question, but how was Mr./Mrs./Miss __________ (subject person)’s standard of living immediately before his/her death?
11EX-18 Question When we interviewed Mr./Mrs./Miss __________ (subject person) in our last visit, we asked about his/her plan for bequests. May I ask you some follow-up questions?
11EX-19 Question When we interviewed Mr./Mrs./Miss __________ (subject person) two years ago, we were told that he/she ( ). Did he/she give any gift before death or leave any inheritance?
11EX-20 Question When we interviewed Mr./Mrs./Miss __________ (subject person) two years ago, we were told that he/she ( ). How much in total did he/she give as gifts before death and inheritance?
11EX-21 Question May I ask who received inheritance from Mr./Mrs./Miss __________ (subject person)?
11EX-22 Question Could you tell me how much each recipient received in terms of percentage share of the total?
11EX-23 Question Thank you very much for your cooperation.